The emergency room paradox

(PHOTODISC) Medicaid is trying to reduce unnecessary emergency room visits, but is running up against a formidable challenge: emergency room marketing campaigns. Kaiser Health News’ Phil Galewitz reports in today’s Washington Post:

Many hospitals are actively recruiting people to come to the ER for non-emergency room reasons,” said Anthony Keck, South Carolina’s Medicaid director, citing facilities that tout their speedy ER service on highway billboards. “When you are advertising on billboards that your ER wait time is three minutes, you are not advertising to stroke and heart attack victims,” he said.

...HCA, the nation’s largest for-profit hospital chain, launched a major ER marketing campaign in the past year in Virginia, Florida, Texas and other states. The campaign includes billboards highlighting average ER waiting times and a service that provides waiting times to smartphone users.

This article is a good case of how the financial incentives in our health care system often don’t work, pointing just about everybody in the wrong direction. The hospital, which receives a fee for every service it provides, has little reason to cut down on emergency room visits. The Medicaid patient, too, has relatively weak incentives to head to the urgent care clinic that would be cheaper for the government. While about half of states charge co-pays for non-urgent emergency room use, they tend to range from $3 to $5. (To be fair, research has questioned whether higher Medicaid co-payments would deter non-urgent ER use. Higher co-pays could also be problematic in threatening access.)

The cost savings -- and potential profits -- at stake here are nothing to sneeze at: A Health Affairs study last year estimated that about a quarter of emergency room visits could have been treated at an urgent care clinic— at a savings of $4.4 billion annually.